The heart in rheumatoid arthritis | Arthritis Information

Abstract

Morbidity and mortality rates are higher in rheumatoid arthritis (RA) patients than in the general population. Many studies have shown that coronary artery disease is one of the most common causes of death in RA and seems to occur at a younger age than in the general population.

RA per se is as much a cardiovascular (CV) risk factor as diabetes, arterial hypertension and dyslipidemia etc., and so it is necessary to plan a follow-up using the same diagnostic and therapeutic approaches as those commonly used for primary and secondary prevention in non-RA patients at high CV risk.

All of the cardiac structures can be affected during the course of RA (valves, the conduction system, the myocardium, endocardium and pericardium, and the coronary arteries), and cardiac complications include a variety of clinical manifestations. As these are all associated with an unfavourable prognosis, it is essential to detect subclinical cardiac involvement in still asymptomatic RA patients in order to assure adequate long-term treatment.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W8V-4XNW474-1&_user=10&_coverDate=04%2F30%2F2010&_rdoc=2&_fmt=high&_orig=browse&_srch=doc-info(%23toc%236664%232010%23999909993%231824712%23FLA%23display%23Volume)&_cdi=6664&_sort=d&_docanchor=&_ct=11&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2828161b46ae7ccd66500c46f6f36644

Been preaching this for the last few years. By the time cardiac symptoms manifest, it's too late to prevent the onset and can only be treated and/or observed for further damage. That's the position I'm in - observation. I had a cardiac issue come up that's directly related to RA. At this point I don't needs meds but I do need yearly cardiac tests. No one was more surprised than me when this happened. I had no symptoms but my preop EKG was abnormal. Cardiac involvement is very sneaky and it's best to be on top of it. Lindy[QUOTE=LinB]Been preaching this for the last few years. By the time cardiac symptoms manifest, it's too late to prevent the onset and can only be treated and/or observed for further damage. That's the position I'm in - observation. I had a cardiac issue come up that's directly related to RA. At this point I don't needs meds but I do need yearly cardiac tests. No one was more surprised than me when this happened. I had no symptoms but my preop EKG was abnormal. Cardiac involvement is very sneaky and it's best to be on top of it. Lindy[/QUOTE]

Very good advice Lindy!

Amen to that Lindy! This is the very reason I say everyone with RA should have a cardiologist on their team! Things heart related are not only sneaky, but often give one little time to react. RA made my valve replacement necessary, and that was a surprise to me too! An annual check is no big deal and the best way to stay on top of things!

Thanks so much Lynn, for valuable information!

Absolutely true. I have a full-blown adenosine GATED stress test every other year. So far, each time I come out better than someone my age and I tell you that kind of news is really welcome. My endocrinologist was very savvy and ten years ago made sure a cardiologist was on my team.

One of the best things you can do is get tested BEFORE trouble starts. Get a baseline.

It pays to stay on top of this. Thanks for the excellent article.

I had pericarditis (inflammation of the lining of the heart) at the outset of Still's disease. I've recently had a "silent" heart attack. And yes, I put the blame squarely on Stills. My treadmill stress test came out perfect (better than average for my age group) and my cholesterol has been termed "great" by my doctor. What other conclusion might I jump to?Here's some interesting info to add. My thyroid NP tested me for homocysteine, unbeknownst to me. It came back off the charts high - 28 and homocysteine should be no higher than 3 (if I recall correctly). The recommendation was double my B vitamins and up fish oils. Homocystein is a marker of inflammation.

Flash forward two months, to my first meeting with a homeopathic physician. She looked at those labs during my primary consult and described in terms I could understand how homocystein can be elevated by poor diet, or it could be a factor in the blood indicating there is inflammation. She asked if I was flaring when the labs were drawn (yes). She then described these inflammation cells as being jagged in shape, barreling through the arteries and bouncing, knocking off the inner arterial walls, causing tiny tears and knicks. The arteries' natural defense mechanism goes to work repairing the knicks and tears. However, over time and constant assault by the homocysteine, the walls begin to thicken with scar tissue, leading to athero sclerosis.

So that is the link (at least one, anyway) between heart disease and RA. I was blown away to hear about these elevated markers for heart disease because I eat a super healthy diet and exercise as much as possible! And my least pre-op was stellar for a good heart.

I suppose it varies, but does it matter how long you have had RA or is it all about inflammation? My rheumy has never mentioned this. If you google "rheumatoid arthritis heart disease and/or cardiac complications you'll get about 8 million hits. Review the first couple of pages and look for writing, studies, research from National Institute of Health (NIH), Cleveland Clinic, Mayo, John Hopkins and you'll have a wealth of info at your fingertips.

GG, most of what I read isn't about how long you've had RA but how much inflammation has occured over the length of time that you've had RA. Talk to your RD about having a cardiac consultation. It's important.

Lindy

[QUOTE=Green~Tara]Here's some interesting info to add. My thyroid NP tested me for homocysteine, unbeknownst to me. It came back off the charts high - 28 and homocysteine should be no higher than 3 (if I recall correctly).[/QUOTE]

The normal range for homocysteine according to my lab is 4-15.4. Mine is run regularly because I take two drugs that falsely elevate homocysteine: Methotrexate and Metformin [diabetes]. And yes, mine was in the 20's, too.

Here are some of my notes on homocysteine. As you can see, you cannot readily assume the worst about elevated homocysteine in the face of so many things that will cause elevation:

May be a marker rather than a cause of vascular disease

Questionable if homocysteine plays a role in the progression of cardiovascular disease (CVD)

American Heart Association has not established a direct correlation between homocysteine levels and heart attacks but does acknowledge strong evidence of a relationship between homocysteine levels and heart attack/stroke survival rates. Blockage of a coronary artery, a precursor to a heart attack, occurs with more than double the average frequency in people with homocysteine levels in the highest 25% as compared to those in the lowest 25%

Patients with even moderately elevated serum or plasma Homocysteine level exhibit increased risk of cardiovascular disease.

Homocysteinuria, a rare genetic disorder, results in high serum or plasma levels of of homocysteine.

Chronic renal failure is also associated with elevated levels.

Deficiencies with either folic acid, vitamin B6 or Vitamin B12 can also produce hyperhomocysteinemia. However, patients taking methotrexate, nicotinic acid, theophylline, nitrous oxide, s-adenosyl-methionine or L-dopa can have falsely elevated serum or plasma homocysteine levels.

Related Tests: Cardiac risk assessment, Vitamin B12, Folate

Homocysteine levels can increase with age, when a patient smokes, and with the use of drugs such as carbamazepine, methotrexate, and phenytoin.

Sam12342010-04-09 19:39:43Sam, once again thank you for your input. MTX strikes again! I knew about the heart stuff, but didn't really pay attention being so young. But, I have had pericarditis and it is scary!

RA is a crazy crazy disease...always something!